Exploring access to health care services in Ukraine: A protection and health perspective - July 2019

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The conflict in eastern Ukraine continues to have a devastating impact on the health and well-being of all affected communities. The conflict has isolated rural health facilities in Government-Controlled Areas (GCA) from major health centers located in urban areas in Non-Government Controlled Areas (NGCA). The insecurity and curtailed access to referral hospitals and pharmacies have undermined the health care system’s ability to cope with both new and pre-existing health care needs, especially for people living in rural areas.

Over 5.2 million people have been directly affected, 3.2 million live within 20 km of the ‘contact line’ and an estimated 1.37 million people are registered as internally displaced persons (IDPs). From 1 January to 30 June 2019, OHCHR recorded 91 conflict-related civilian casualties: 13 killed and 78 injured. Protection and access to health care services are of particular concern because 30% of those affected are older people (60 years old and over), and 60% are women and children. Persons with disabilities and GBV survivors are also particularly affected by lack of access to health services. According to HelpAge International, 97% of older people have at least one chronic disease and over half (53%) require assistive devices. The vast majority (96%) also report experiencing conflict-related mental health issues. More than 240,000 children living near the ‘contact line’ regularly experience shelling and exposure to landmines, Explosive Remnants of War (ERWs) and unexploded ordnances. The ongoing conflict has put children and their families at greater risk of developing health problems, ranging from traumatic injuries to infectious diseases, as a result of exposure to the conflict, stress, lack of access to adequate nutrition and health services.

Meaningful access to health care and medicine is a key health and protection concern for many people living in conflict-affected regions, particularly for those living near the ‘contact line’ and in NGCA, as well as those crossing the contact line. Conflict-affected people living along the contact line often face barriers in access to healthcare such as distance, cost of travel, cost and availability of medication, availability of medical personnel, and limited accessibility of ambulances due to the security situation. The long-term implications for morbidity and mortality from untreated illnesses and injuries caused by this protracted conflict will not only diminish the sustainability of future reconstruction and development efforts but will also potentially have intergenerational implications. International funding is crucial to provide health care services in conflict-affected eastern Ukraine, as well as to IDPs, yet the level of health funding of the Humanitarian Response Plan (HRP) projects over last five years has decreased from 98% in 2014 to 38% in 2018.